Timing Half of all infant deaths happened on the first day of life. Another 25% happened within the first month.

50% <1 Day Old

• Racial Disparity

The black infant mortality rate was more than twice the white infant mortality rate at 13 deaths per 1 ,000 for black infants compared to 6.2 for white infants

• White (40%) • Black (60%)

Smoking Before and During Pregnancy, MS

---

Before Pregnancy During Pregnancy

• 2014 • 2015

10% Of Mississippi women giving

0 birth in 2015 smoked at somepoint during pregnancy

13 %

Of women who smoked0 bef?re pregnancy, quit

during pregnancy

14% Of mothers whose infantdied in 2014 smoked during pregnancy

Source, MS Vital Statistics, 2015

Trends 2014 brought the lowest infant mortality rate in Mississippi, which was preceded by an overall declining trend since 2010. The infant mortality rate across all groups increased in 2015, with the black infant mortality rate reaching its highest level since 2011.There was a widening in the disparity in infant deaths between white and black infants during this time .

Source: Mississippi Vital Statistics, 2010-2015

Maternal Health A mother's health and medical care before and during pregnancy can directly impact infant health and the risk of infant mortality. Three key areas of preconception health that can impact infant health include 1) exposure to tobacco before and during pregnancy, 2) the presence and management of chronic medical conditions and 3) if a woman plans her pregnancies.

Chronic Medical Conditions MS, Females Age 18-44

Obesity Hypertension Diabetes

·-Source, MS BRFSS, 2015

Women entering pregnancy with medical conditions like obesity, hypertension (HTN) and diabetes are at an increased risk of complications like preterm birth and stillbirth. Poorly controlled diabetes can lead to birth defects. Black women have higher rates of these preexisting conditions.

2010

2011

Unintended Pregnancy MS Females, 2010, 2011

• Planned • Unplanned

34% 66%

45% 55%

Source, MS PRAMS, 2010-2011

In 2011, there were fewer unintended pregnancies than 2010 (most recent data). However, more than half of pregnancies were unplanned. Women who plan their pregnancies are less likely to smoke and are more likely to start prenatal care early and take folic acid to prevent birth defects.

Strategies for Improvement Reducing Preterm Birth & Preterm Related Mortality

Improving Maternal Health

.TOBACCO CESSATION

• PROGESTERONE THERAPY The MSDH Office of Tobacco Control trains providers in evidence-based

Progesterone medication can reduce techniques to assist pregnant women the risk of preterm birth in select high- to stop smoking. Smoke-Free Air risk patients. Pregnant women need to policies help reduce second-hand be screened for a history of exposure. spontaneous preterm birth or have an ultrasound of the cervix to determine if they are candidates for this therapy.

• LOW DOSE ASPIRIN

Preeclampsia is a pregnancy relatedcondition that causes severely highblood pressures and can lead tomaternal and fetal death. It is one ofthe leading causes of preterm birth.Low dose aspirin can help preventpreeclampsia in certain women andreduce the risk preterm birth.

MSDH is working with the March ofDimes and multiple partners toaddress these areas.

Key Partnerships & Programs N A T 0 N A L

NF(MR FETAL- INFANT MORTALITY REVIEW PROGRAM

The Fetal-Infant Mortality Review Program uses local case review teams and community action teams to identify solutions for infant mortality. Mississippi now has three active FIMR programs- in District VIII, IX and the Delta and will be developing programs statewide.

The Mississippi Perinatal Quality Collaborative is a multi-stakeholder partnership dedicated to improving birth outcomes through evidence-based statewide initiatives. MSPQC participants are currently working to improve the care of high-risk newborns during the first 'Golden Hour' of life, reduce maternal mortality caused by obstetric hemorrhage and improve breastfeeding rates.

The Sisters United Program of the MSDH Office of Health Disparity Elimination aims to address the disproportionately high infant mortality rates among African-Americans in Mississippi. Sisters United trains African-American sorority members to engage in community education and outreach.

Communities and Hospitals Advancing Maternity Practices is a breastfeeding-focused initiative geared toward improving maternal and child health outcomes through the promotion of the Baby-Friendly Hospital Initiative (BFHI). The BFHI is a global program launched to encourage and recognize hospitals that offer an optimal level of care for infant feeding and mother/baby bonding. MSDH is working with CHAMPS as well as Blue­

Cross Blue Shield of Mississippi to support hospitals pursuing Baby-Friendly status in Mississippi and increase breastfeeding rates across the state.

Reducing SIDS & Sleep-Related Deaths

• HOSPITAL SAFE SLEEP

Hospital safe-sleep policies and programs ensure that every new parent is educated about recommended infant sleep guidelines to prevent SIDS and sleep related deaths. MSDH and the MS SIDS and Infant Safety Alliance are working to promote these policies statewide .

• DIRECT ON SCENE EDUCATION

Increase Breastfeeding • HOSPITAL & COMMUNITY TRAINING

Breastmilk has been proven to reducethe risk of neonatal illness and SIDS.Breast milk is particularly beneficial topreterm and low birthweight infants.MSDH is working with multiplepartners to strengthen breastfeedingsupport within hospitals andcommunities.

Acknowledgements The Mississippi State Department of Health first acknowledges the families touched by infant death each year. This report is generated with the goal of preventing these tragic losses.

Data for this report are made available by the Office of Vital Records and the Office of Health Data and Research.

Corresponding Author: Charlene Collier, MD, MPH, MHS Charlene.Collier@msdh.ms.gov

Contributors & Data Analysts:

Richard Johnson, MS Monica Stinson, MS, CHES Meagan Robinson, MPH Rodolfo Vargas. MS Lei Zhang, PhD, MBA, MSc

LARCs include intrauterine devices and subdermal hormonal implants. They are twenty times more effective than most other forms of birth control and help women to improve their health before pregnancy and space births adequately. MSDH is working with Medicaid and other partners to expand access to LARCs.

.LONG-ACTING REVERSIBLECONTRACEPTION (LARC)

The Direct on Scene Education (DOSE) program trains first responders, including fire fighters and emergency medical technicians, to screen the homes they enter for unsafe infant sleep environments and provide education and cribs to families. MSDH is working to implement DOSE across the state.